More Docs Use EHRs, but Info Still Not Shared

by David Pittman David Pittman,Washington Correspondent, MedPage Today
November 15, 2012

The number of U.S. primary care physicians using electronic medical records increased by 50% in the last 3 years, but most doctors still do not receive timely information from specialists or hospitals, an international survey found.

Roughly 69% of U.S. primary care doctors reported using EHRs in 2012 compared with 46% in 2009, the survey published in the journal Health Affairs found. The 2012 number put the U.S. in the middle among the 10 nations surveyed -- only 41% of Swiss physicians used EHRs, compared with 98% of Norwegian physicians.

But despite the increase in their use of EHRs, only 11% of U.S. doctors said information they receive about their patients from specialists is timely, and only 26% are told by a hospital that their patient has been discharged, Cathy Schoen, senior vice president of policy, research, and evaluation at the Commonwealth Fund in New York City, and colleagues found.

"Lack of integration between primary care, speciality care, and hospitals can put patients at risk and result in duplicative care, particularly for patients with complex chronic illnesses," the authors wrote.

One goal of U.S. health reform has been to create a more integrated care system to foster coordination and teamwork among primary care providers, specialists, and hospitals. EHRs can help support that.

The researchers surveyed primary care doctors in 10 countries and compared results from a similar survey from 3 years ago to see how primary care has changed. They polled between 500 and 2,000 general practice and family practice physicians, general internists, and pediatricians in each country. Countries in the survey included Australia, Canada, France, Germany, the Netherlands, New Zealand, Norway, Switzerland, the U.K., and the U.S.

"The survey findings indicate that national policies make a difference, particularly for patient access, physicians' use of health information technology, and availability of information regarding practice performance," the authors wrote. "Yet the study also points to the common challenge across countries of improving communication and teamwork across sites of care to ensure patient-centered and efficient healthcare systems."

Stage 2 of the Department of Health and Human Services' EHR Meaningful Use incentive program takes effect in 2014 for providers and intends to lay the foundation for further interoperability.

"Meaningful use" refers to provisions in the 2009 Health Information Technology for Economic and Clinical Health (HITECH) Act, which authorized incentive payments through Medicare and Medicaid to clinicians and hospitals that use EHRs in a meaningful way that significantly improves clinical care.

But in Thursday's Health Affairs study, only 31% of American doctors said they can electronically exchange patient summaries and test results with doctors outside their practice.

The electronic exchange of patient information is not yet the norm in any country, the authors found. Not surprisingly, the survey found larger practices are more likely to use EHRs than smaller ones.

Of the 1,012 surveyed in the U.S., 34% of primary care doctors answer patient questions via email, 30% of patients can request appointments or referrals online, and 36% can request prescription refills online.

"Increasingly, primary care practices can offer new forms of electronic access beyond office visits, such as through e-mail and web-based portals," Schoen and colleagues found.

Other notable findings from the report include:

American physician practices in an integrated system were more likely to receive performance information.

Across all countries, practices with more robust capacity in health information technology were more likely to report performance feedback.

19% of U.S. doctors report receiving all relevant health information when their patient sees a specialist and 16% are notified of changes to a patient's care plan.

U.S. and German physicians were also least likely to say they were satisfied or very satisfied with practicing medicine.

Despite the findings, results are a bit difficult to extrapolate internationally. The surveyed countries varied in the extent to which primary care is the gateway to more specialized care and in the way primary care physicians are paid.

"In summary, the redesign of primary care is central to reforms aimed at improving health system performance," the authors wrote. "As a result, there are opportunities to learn from diverse efforts under way in the U.S. and other countries that are designed to achieve shared health reform goals."

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